Patient Education Exchange: Getting Ahead of IBD Inflammation With Biologic Therapy

For many people with inflammatory bowel disease (IBD), the idea of starting a biologic can feel overwhelming. At “A Patient Conversation on Managing IBD,” held at The Westin Denver Downtown, Matthew Nichols, M.D., of South Denver Gastroenterology, explained how he walks patients through the decision.

Interrupting the Signals Behind Inflammation

Nichols said biologics work by targeting the pathways cells use to communicate, intercepting those signals to control inflammation. Different biologics act on different pathways, so the first step is to determine what a patient’s body is telling the care team.

He looks for a therapy that meets four goals.

“It’s got to be efficacious, meaning it’s got to work. It’s got to be safe. It’s got to be a route that we’re all happy with, whether that’s IV or injection or whatever, and we’ve got to be able to get it for you, right?” he said.

Why Waiting Can Cost More

According to Nichols, patients often experience IBD as a cycle of flares that get brought under control. Inside the body, though, the damage adds up over time, and it can lead to complications, surgery and hospitalization. Spotting risk factors early lets doctors start advanced therapy before those problems develop, while leaving time to fine-tune treatment.

Safety is usually patients’ biggest worry. Nichols said he reassures them that each therapy is regularly reassessed, and that a medication that isn’t tolerated or isn’t working gets stopped.

“We stress over the decisions we’re making, but we tend to regret the decisions we should have made,” he said.

Tracking Progress and Passing the Baton

Because biologics can take time to work, Nichols follows markers such as fecal calprotectin, a stool test that measures intestinal inflammation.

“You can think of it kind of like the smoke over the fire. If you see the smoke clearing, probably the fire is getting better,” he said.

He compared treatment to a relay race.

“Steroids, which are a good first runner, get inflammation under control, and then we pass the baton on to the second runner, give that second runner time to come up to speed, which is the biologic therapy,” he said.

Clearing Insurance Hurdles

Access can be the toughest of the four goals. Nichols recommends starting the authorization process right away and signing up for manufacturer patient support programs, which can sometimes help patients get medications even after an insurance denial. If the first choice isn’t available, he said there are usually other strong options.

Above all, he encourages patients to picture what feeling better would look like, whether that’s going out to dinner, dating or returning to work.

“What would be the things you would be doing if you felt healthy again?” he said.